MEDICARE: MRS. CHERYL D DAANE LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	17408031	WI

General Provider Information

NPI Number	:	1841223005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHERYL D DAANE LPN

Provider Business Mailing Address
First Line	:	W162N8241 TAMARACK CT
Second Line	:
City	:	MENOMONEE FALLS
State	:	WI
Zip	:	53051-3607
Country	:	US
Telephone Number	:	262-251-1367
Fax Number	:	262-523-1910

Provider Business Practice Location Address
First Line	:	W162N8241 TAMARACK CT
Second Line	:
City	:	MENOMONEE FALLS
State	:	WI
Zip	:	53051-3607
Country	:	US
Telephone Number	:	262-251-1367
Fax Number	:	262-523-1910

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	07/08/2007

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